report of the technical assistance provided to the ......national sanitation campaign, government of...

Report of the Technical Assistance provided to the National Sanitation Campaign, Government of TanzaniaC. Ajith Kumar

May 2015

Enabling Rural Sanitation Demand and Supply

Water and Sanitation Program: TECHNICAL PAPER

the Water and Sanitation Program is a multi-donor partnership, part of the World Bank group’s Water global Practice, supporting poor people in obtaining affordable, safe, and sustainable access to water and sanitation services.


Author: C. Ajith Kumar (Senior Water and Sanitation

Specialist)

Photos: Helena Goldon/WSP/World Bank

AcknowledgementsThe report has benefitted from an extensive review

from within WSP and across the World Bank.

From within WSP, the Handbook was reviewed by Glenn

Pearce-Oroz (Principal Regional Team Leader for Africa),

Yolande Coombes (Senior Sanitation and Hygiene

Specialist and Regional Business Leader for Scaling Up

Rural Sanitation for Africa), Kaposo Boniface Mwambuli

(Water and Sanitation Specialist), Craig Kullman (Senior

Water and Sanitation Specialist), Emily Christensen

Rand (Water and Sanitation Specialist) as well as

consultants Elizabeth Clementine Loughnan and Sophie

Hickling. On the World Bank side, the handbook was

peer reviewed by Rekha Menon (Program Leader),

Yitbarek Tessema (Lead Water and Sanitation

Specialist), and Yahya Ipuge (Senior Health Specialist).

We also need to acknowledge the support provided by

the Knowledge Management Team: Magdaline Ncabira

Nkando (Senior Knowledge Management Specialist),

Norah Akuku Osoro (Program Assistant), and Helena

Goldon (Consultant, In-Country Knowledge Management)

as well as the ACS (Grace Joy and Lizzie Mwakyami)

throughout the process of compiling this report.

The Water and Sanitation Program is a multi-donor partnership, part of

the World Bank Group’s Water Global Practice, supporting poor people

in obtaining affordable, safe, and sustainable access to water and

sanitation services. WSP’s donors include Australia, Austria, Denmark,

Finland, France, the Bill & Melinda Gates Foundation, Luxembourg,

Netherlands, Norway, Sweden, Switzerland, United Kingdom, United

States, and the World Bank.

Disclaimer

The findings, interpretations, and conclusions expressed herein

are entirely those of the author and should not be attributed to the

World Bank or its affiliated organizations, or to members of the Board

of Executive Directors of the World Bank or the governments they

represent. The World Bank does not guarantee the accuracy of the

data included in this work. The boundaries, colors, denominations, and

other information shown on any map in this work do not imply any

judgment on the part of the World Bank concerning the legal status of

any territory or the endorsement or acceptance of such boundaries.

Copyright Statement

The material in this work is subject to copyright. Because The World

Bank encourages dissemination of its knowledge, this work may be

reproduced, in whole or in part, for noncommercial purposes as long

as full attribution to the work is given.

© 2015 International Bank for Reconstruction and Development/The

World Bank

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Report of the Technical Assistance provided to the National Sanitation Campaign, Government of TanzaniaC. Ajith Kumar

May 2015


iv Enabling Rural Sanitation Demand and Supply

table of Contents

Acronyms and abbreviations ........................................................................................................................................3Executive summary .......................................................................................................................................................5

I. Background ............................................................................................................................................................7II. Introduction ............................................................................................................................................................7 2.1. Sanitation in tanzania .....................................................................................................................................7 2.2. efforts to address the challenge .....................................................................................................................8

2.2.1. Process of implementation of the nSC ................................................................................................9III. Technical assistance by WSP ..............................................................................................................................10 3.1. methodology of providing the ta ..................................................................................................................11 3.2. SUrS theory of change ...............................................................................................................................14 3.3. Creating the enabling environment ...............................................................................................................15

3.3.1. Policy, strategy and direction .............................................................................................................163.3.2. institutional arrangement ...................................................................................................................173.3.3. Program methodology.......................................................................................................................183.3.4. implementation capacity ...................................................................................................................193.3.5. availability of products and tools .......................................................................................................233.3.6. Financing ..........................................................................................................................................243.3.7. Cost-effective implementation ...........................................................................................................243.3.8. monitoring and evaluation .................................................................................................................25

3.4. Learning and knowledge management .........................................................................................................26Results, Lessons Learned and Recommendations ...................................................................................................28IV. Transformation of the Sanitation Sector in Tanzania ..........................................................................................29V. Learning from the TA ............................................................................................................................................31VI. Recommendations for strengthening of NSC .....................................................................................................32

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acronyms and abbreviations

AfDB African Development BankBCC Behavioral Change CommunicationBRN Big Results Now InitiativeCBO Community-Based OrganizationCCT Conditional Cash TransferCHW Community Health WorkerCLTS Community-Led Total SanitationDFID Department for International DevelopmentDHS Demographic Health SurveyEE Enabling EnvironmentELN Emergent Learning NoteGDP Gross domestic productGoT Government of TanzaniaHSSP Health Sector Strategic PlanIDA International Development Association/

World BankIFC International Finance Corporation/World

BankJMP Joint Monitoring ProgramJSM Joint Supervision MissionLGA Local Government AuthorityMFI Microfinance institutionMIS Management information systemMKUKUTA National Strategy for Growth and Poverty

ReductionMOHSW Ministry of Health and Social WelfareMOU Memorandum of UnderstandingMOW Ministry of WaterMOEVT Ministry of Education and Vocational

TrainingNAWAPO National Water PolicyNBS National Bureau of StatisticsNGO Non-Government Authority

NSC National Sanitation CampaignNSMIS National Sanitation MISOD Open DefecationO&M Operation and MaintenancePAA Project Area AuthoritiesPMO-RALG Prime Minister’s Office – Regional and

Local GovernmentPSSN Productive Social Safety NetRBF Results-Based FinancingRHMT Regional Health Management TeamRWF Regional WASH FacilitatorRWST Regional Water and Sanitation TeamSACCO Saving and Credit Cooperative

OrganizationSDG Sustainable Development GoalSDN Sustainable Development Network/World

BankSM Sanitation MarketingSURS Scaling Up Rural SanitationSWA Sanitation and Water for AllSWAp Sector Wide ApproachTA Technical AssistanceTOR Terms of ReferenceTSSM Total Sanitation and Sanitation MarketingTWG Technical Working GroupUNICEF The United Nations Children’s FundUSD United States dollarWASH Water, sanitation and hygieneWBG World Bank GroupWHO World Health OrganizationWSDP Water Sector Development ProgramWSP Water and Sanitation ProgramWSWG Water Sector Working Group

vi Enabling Rural Sanitation Demand and Supply

<?> UNICEF-WHO Joint Monitoring Programme, (2010)

The technical assistance (TA), Enabling Rural Sanitation Demand and Supply, was provided by WSP to the National Sanitation Campaign (NSC) in Tanzania, from 2012-15. The TA’s objective was to strengthen the enabling environment, demand creation and enabling supply in the NSC, in order to help the government reach 7 million people with improved sanitation. The TA assisted the government and WBG operations to scale rural sanitation through the development of a joint results framework.

While basic sanitation coverage is high in Tanzania with approximately 70-90% of rural households having access to some sort of latrine, perhaps as few as 7% of the poor and non-poor rural population has access to an improved sanitation facility1. This causes significant health and economic losses to the people and the economy of the country.

The efforts by the country in the 1970s through a campaign, ‘Mtu ni Afya’ (‘Healthy Man’ campaign) resulted in the country moving from open defecation to fixed point unimproved sanitation. The NSC seeks to shift the population from unimproved and open defecation to improved sanitation. The technical assistance provided by WSP supports this shift by supporting the strengthening of the enabling environment, demand creation and enabling supply in the NSC. It was delivered at national and subnational levels. At the former, it provided support to build capacities of government counterparts responsible for policy formulation and national level operations. At the latter, it involved support to strengthen supervision and implementation of the NSC by providing technical assistance through regional authorities.

The TA was provided based on WSP’s Theory of Change for Scaling up Rural Sanitation (SURS), by addressing the following four pillars: Strengthening the Enabling Environment, Creating Demand for Improved Sanitation, Strengthening Supply, and Learning and Knowledge creation, to influence program implementation. Within the

Executive Summary

enabling environment, it sought to influence these eight dimensions: Policy, strategy and direction, Institutional arrangement, Program methodology, Implementation capacity, availability of products and tools, financing, Cost-effective implementation, and Monitoring and evaluation.

The TA worked with the Ministries and Development Partners, to come out with a draft national sanitation policy (approved at the ministerial level); helped set up institutional structures for sanitation combining four ministries and local governments, including partnership agreements; helped define and strengthen the program delivery approach; build capacities of the institutions; facilitated the availability of products and tools’ helped access financing and address cost effective implementation; and set up a robust sanitation monitoring system. Under the learning component, a series of evidence based knowledge management activities were undertaken, which informed the policy and implementation of the NSC.

The TA helped the design and implementation of the NSC, leading to significant changes in the enabling environment and results on the ground. The main learning from the TA were that an evidence based advocacy works to change the environment; however, this takes time to translate to changes on the ground; further engagement on enabling environment at local government is important to bring about accelerated progress on the ground; while doing this, the capacity at the local government level is an important factor.

In the next five years, the NSC should increase its focus on attaining the indicators of the Sustainable Development Goals (SDGs), strengthen its monitoring system to help in planning, implementation and achieving sustainability, and explore partnerships with private sector, including finance institutions, for delivery of financial and sanitation products and services.

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BackgroundI.Most Tanzanian households have a toilet (about 86%, as per Tanzania Demographic Health Survey 2010) with little ‘Open Defecation’ in its traditional understanding; however, most of these (71%) are unimproved toilets, which by exposing the feces, pose a health hazard, equal or even greater than open defecation. The National Sanitation Campaign (NSC) is the flagship program of the Government of Tanzania to address this challenge of unimproved sanitation and open defecation in the country. It is implemented under the Water Sector Development Program (WSDP), a Sector Wide Approach (SWAp) program, supported by World Bank (IDA) and other development partners. It supports the government increase access to improved sanitation and hygiene. This product focused on strengthening sanitation demand and supply models, within the NSC. The Technical Assistance (TA) was delivered at national and subnational levels.

The three-year TA was built on earlier implementation experience in working with the GoT on rural sanitation pilot experiences, and is linked to the WSP’s global sanitation technical assistance. It was built on broad knowledge generated in 17 countries in three regions. It was also being carried out in collaboration with a related TA focusing on improving sanitation performance monitoring. While this TA focuses on enabling increases in sanitation access, the effort to improve performance monitoring supported performance reviews to monitoring sanitation access, to improve learning about sanitation supply and demand and related programming decisions.

2 Enabling Rural Sanitation Demand and Supply

2 UNICEF-WHO Joint Monitoring Programme (2014)3 Ibid.4 PricewaterhouseCoopers Limited , (2009), “Market Research Assessment in Rural Tanzania for New Approaches to Stimulate and Scale up Sanitation Demand and Supply”

2.1. Sanitation in Tanzania While basic sanitation coverage is high in Tanzania with approximately 70-90% of rural households having access to some sort of latrine, perhaps as few as 7% of the poor and non-poor rural population has access to an improved sanitation facility2, with coverage barely keeping up with population growth since 1990.

In Tanzania, government strategy dictates that an improved sanitation facility should also include a place where hands can be washed with soap and water. A study by the Ministry of Health and Social Welfare indicated that only 31.3 per cent of latrines had hand washing facilities, 50% of families wash hands in shared containers3, while research carried out by WSP4 indicated that 83% of the households did not have access to hand washing facilities at the latrine they used.

The low-quality of many latrines in rural areas combined with open defecation, and unsafe disposal of children’s stools may be holding many communities back from realizing the health and economic benefits of sanitation. Diarrhea prevalence is relatively high and growing at 15 percent for under-five-year-olds (<5) children, with children under 11 months suffering the most. In addition, WSP and MOHSW estimate that poor sanitation causes about TZS 301 billion (USD 206 million) or about 1% of GDP to be lost every year due to premature death, illness, lost time and productivity.

2.2. Efforts to address the challenge Tanzania had phenomenal success in the 1970s with the approach ‘Mtu ni Afya’ (‘Healthy Man’ campaign) that is largely credited with improving large scale access to basic sanitation. It focused on behavior change rather than germ theories or use of hardware subsidies. It used various channels, such as radio campaigns, peer pressure and

IntroductionII.enforcement, to move people away from open defecation to individual household toilets. This resulted in about 80% of the population currently using a toilet, albeit an unimproved one. Efforts since then to do away with open defecation or upgrade to an improved toilet were few and far between, and if any, scattered pilots.

In 2008-11, Ministry of Health and Social Welfare, partnering with the Water and Sanitation Program (WSP), initiated the Total Sanitation and Sanitation Marketing (TSSM) project in 10 districts of Tanzania, as a ‘pilot-at-scale’ program. Using the emerging approaches like Community-Led Total Sanitation (CLTS) and Sanitation Marketing (SM), the TSSM was able to support thousands of households gain access to improved sanitation.

In 2010, the National Strategy for Growth and Poverty Reduction II 2010 – 2015 (known by its Swahili acronym, MKUKUTA II) provided sanitation targets for improved household toilets at 35% in rural areas and 45% in urban settings by 2015.

As part of the restructuring of the Water Sector Development Program in 2010, a National Sanitation Campaign (NSC) was added as part of the rural water and sanitation component. The lead agency in implementing the National Sanitation Campaign is the MOHSW in collaboration with the MOW, MOEVT, and PMO-RALG. These agencies have drafted a Participation Agreement to guide the management of the campaign. Officially launched by the President of the United Republic of Tanzania in June 2012, the NSC’s initial funding of USD 20 million was committed by the AfDB, with DFID committing an additional USD 3.5 million in March, 2012. Disbursements for the campaign began in November, 2012, with implementation starting in 2013.

The NSC is aiming to lead to 7 million Tanzanians gaining access to improved sanitation by 2015. The MOHSW initially targeted 40 districts and intends to phase in all 168 districts by 2015. About 65% of the funding is to be provided directly to local governments for household sanitation

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Report of the Technical Assistance provided to the National Sanitation Campaign, Government of Tanzania | Introduction

Introductionpromotion and school infrastructure improvement with the balance for national and regional level activities. In the longer term, the government is planning to grow the campaign to reach an additional 20 million. The campaign’s concept note, results framework and work plans outline the use of CLTS, sanitation marketing and other approaches as well as roles of national, regional, and local authorities.

2.2.1. Process of implementation of the NSC While the NSC is a major milestone in the achievement of sanitation outcomes in the country, there implementation has been faced with certain challenges.

• The NSC is an ambitious program in scope given the lack of a nation-wide program in sanitation in recent years. While a number of sanitation

approaches, such as Community-Led Total Sanitation (CLTS) and Sanitation Marketing are showing promising results and have helped to shape the campaign’s direction, these have yet to be demonstrated at a national scale.

• The capacity of the institutions at various levels, especially the Regional Authorities and Local Government Authorities (LGAs) has been found to be a constraint in the implementation of the campaign.

• An integrated approach to sanitation service delivery across the country has improved during the timeline of this TA, however, there are still some organizations implementing disparate programs, using different approaches.


The technical assistance (TA) provided by WSP to the NSC from 2012-15 was built on an earlier ‘pilot-at-scale’ project undertaken from 2007-12, by the Ministry of Health and Social Welfare with support from WSP. The Community-Led Total Sanitation (CLTS) and Sanitation Marketing (SM) approaches, which were effectively used during this pilot, were the building blocks of the NSC.

The TA’s objective was to strengthen the enabling environment, demand creation and enabling supply in the NSC and the Water Sector Development Program (WSDP), through which the campaign is delivered, in order to help the government reach 7 million people with improved sanitation. The TA intended to assist the government and WBG operations to scale rural sanitation through the development of a joint results framework and the use of promising approaches from experiences in Tanzania and elsewhere. The results framework included objectives of improving sanitation demand and enabling the supply of goods and services. The TA also sought to help lay the foundations for the government’s longer term Sanitation and Water for All (SWA) vision of having an additional 20 million people gain access to improved sanitation by 2025 and inform future WBG and development partner operations.

It was in line with the objective of the National Growth and Poverty Reduction Strategy’s (MKUKUTA II’s) to increase access to improved sanitation access in rural areas which includes improved latrines and hand washing facilities. It was also in line with the World Bank’s Country Assistance Strategy agreed with the Government of Tanzania which seeks to improve access to quality water and sanitation services in the country in support of MKUKUTA II. It supported the IDA funded Water Sector Support Program (P087154), a multi donor government-led sector wide approach.

3.1. Methodology of providing the TAThis TA was undertaken at two levels, at the national and subnational levels. The focus of the TA at national level

Technical assistance by WSP III.was on creating a policy and enabling environment, while at subnational level, it was on providing Implementation Support.

• National Level: At the national level, the TA provided support to build capacities of government counterparts responsible for policy formulation and national level operations though the WSDP and the National Sanitation Campaign. This included delivering expertise and guidance in the areas of sanitation marketing, evidenced-based advocacy, program management, policy dissemination, operational research as well as constructive reviews of government outputs such as TORs and progress reports. In addition, the TA also linked up with similar programs to address the poor in rural areas; this included the development of a partnership with the Productive Social Safety Net (PSSN) project, supported by the World Bank and other partners, a Conditional Cash Transfer (CCT) project to help those below the poverty line in Tanzania. Using the implementation structure of the project, a sanitation component was introduced in the messaging.

• Subnational Level: This level involved working at subnational level to strengthen supervision and implementation of the NSC by providing technical assistance through regional authorities. Initially, 12 out of the 25 regions were identified for this support, the regions having been selected by WSP in consultation with the Ministry through a mix of demand-led (regions demanding support) and supply-led (MOHSW preferences and logistics) indicators (see Box 1).

At a later stage, this support is expected to move to the other regions of the country. This support included positioning of Regional Wash Facilitators (RWFs) in all the 12 regions, and through them, working with the regions to plan for and supervise sanitation strategies and activities, and periodically share lessons across regional and local government authorities. The support was focused on

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Report of the Technical Assistance provided to the National Sanitation Campaign, Government of Tanzania | Technical assistance by WSP

Box 1: SELECTION CRITERIA DEVELOPED By WSP IN CONSULTATION WITH MOHSW FOR REGIONS TO BE SELECTED FOR TA SUPPORT By WSP

Regions selection criteria (40%):

1. Poverty index estimation (Tanzania Social Action Fund (TASAF) estimated poverty index for each (PAA) Project Area Authorities (and mtaa/village/ward) in Tanzania mainland and Zanzibar. (10%)

2. MOHSW priority regions (8%)

3. Sanitation indicators (e.g. Number of households with improved sanitation in the program area, number of households with hand washing facilities, number of sub villages verified ODF or 100% improved latrine coverage etc.) (10%)

4. Geographical location: Priority will be given to remote regions (distance from capital/commercial centres) (7%)

5. Financial utilization (5%)

Regions readiness indicators (60%):

Each indicator to include a priority ( (1) or (2) ); agreement to priority (1) indicators by the region is mandatory to include that region for consideration of the TA

• Regional submission of the application for the Technical Assistance (1) (15%)

• Provision of working space for the Regional Coordinator and other important working tools such as desk, table and access to other basic facilities and services that are offered to the RHMT e.g. Regional Health Officer (2) (10%)

• Provision of support, including the Regional Coordinator’s access to information e. g. budget allocated for NSC activities, provision of introductory letters when needed; regions follow up on status of NSC activities, provision of feedback etc. (1) (15%)

• Willingness to engage the Regional Coordinator in WASH meetings that are carried at the regional level and districts. Where necessary such meetings may include monthly progress review , quarterly performance review meetings and the participation in the supportive supervision visits for WASH activities. (2) (10%)

• Willingness to engage Regional Coordinator to work with other stakeholders to improve the overall enabling at the national and regional levels. (2) (10%)

making a change to the National Sanitation Campaign indicators such as number of people gaining access to sanitation, numbers of sanitation service provides, and number of villages that have made declarations to improve sanitation access. The support at subnational level also strengthened the role of the Prime Minister’s Office for Local Government, the Regional Authorities and LGAs, and brought sanitation implementation in line with the reporting and accountability structure of regional authorities and local governments.

The subnational TA support has been in operation since April 2014; since then, some progress has been noted in the 12 regions where the TA is being provided. One of this includes the featuring of some of the districts, which are under these regions, in the higher ranks of performing districts in the National Sanitation League Table (those districts that have met above 75% of their target). For example, in the sanitation league table that came out in June 2014, 16 districts from the TA regions achieved above 75%; whereas in the one that came out in September, 2014, 23 districts from the TA regions achieved above 75%.


FIGURE 1: NATIONAL SANITATION CAMPAIGNS TA REGIONS

Additionally, Regional Water and Sanitation Teams (RWSTs) from some of the regions that used to be inactive for long time, are now becoming active and engaged. MOHSW has started to receive regular regional reports from those regions, some examples, according to the MOHSW focal person, being Katavi and Simiyu regions.

Following such progress, the MOHSW has begun to consider extending support, including RWFs, to the remaining regions.

missions with clients and partners. The TA developed a set of activities in consultation with clients and partners. The TA allowed for government review of input design and of outputs at national and subnational levels.

3.2. SURS Theory of changeThe TA was provided to the NSC based on WSP’s Theory of Change for Scaling up Rural Sanitation (SURS). The Theory of Change proposes addressing the following four pillars to enable ‘at scale’ transformation of the sanitation sector in a country, in the form of open defecation free communities:

1. Strengthening the Enabling Environment2. Creating Demand for Improved Sanitation3. Strengthening Supply4. Learning and Knowledge creation, to influence

program implementation

Influencing the Enabling Environment is one of the key elements of this theory of change, to bring about sustainable sanitation outcomes ‘at scale’. The enabling environment has these eight dimensions:

1. Policy, strategy and direction2. Institutional arrangement 3. Program methodology4. Implementation capacity 5. Availability of products and tools

The assistance took a learning–by–doing approach to broker stakeholder participation and ownership, with regional lessons feeding up to the national level to inform efforts to accelerate sanitation programming nationwide. This involved delivering inputs through national dialogue structures including the development partners group for water and sanitation, sanitation working groups, and joint


FIGURE 2: WSP THEORy OF CHANGE FOR SCALING UP RURAL SANITATION (SURS)

Strenghthen Enabling Environment

Strenghthen Supply Learning and Knowledge

Generate Demand for Improved Sanitation

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6. Financing 7. Cost-effective implementation8. Monitoring and evaluation

The Technical Assistance provided to the NSC in Tanzania, was structured around the four pillars of the theory of change, including the eight dimensions of the Enabling Environment framework.

3.3. Creating the enabling environmentThe creation of an enabling environment is essential for an ‘at scale’ delivery of sanitation service delivery outcomes. While small scale pilots can deliver positive results in a short span of time, these tend to involve a higher level of software inputs. When scaling up an intervention is required, with its commensurate lack of resources (human personnel, skills and financial), the presence of an enabling environment is inevitable. The various dimensions of the enabling environment, though varying in its importance and negotiability, have to be addressed to ensure that the outcomes are achieved ‘at scale’.

3.3.1. Policy, strategy and directionIn Tanzania, the introduction of the National Sanitation Campaign was a major milestone in the country’s efforts to address its sanitation challenge. The previous effort nationwide to have a full-fledged campaign across the country was in the 70s, when the Mtu ni Afya (Healthy Man) campaign was launched. Launched by the father of the nation, the then President Julius Nyerere, this campaign is credited with moving people away from open defecation to a fixed point defecation, in a toilet. Although the toilets constructed were unimproved, the campaign itself was highly successful in effecting a behavior change among about 80% of the population.

Subsequent to the above campaign, there were smaller pilots involving a few villages, wards, or districts undertaken across various parts of the country by NGOs, donors or governments. The ten districts ‘pilot at scale’, Total Sanitation and Sanitation Marketing (TSSM), undertaken from 2008-11 by the Ministry of Health and Social Welfare with the support of WSP, may perhaps be the largest ever focused initiative undertaken to address sanitation in the last few decades.

The inclusion of sanitation as a major component in 2011, in the Water Sector Development Program, implemented by IDA and other development partners through a Sector Wide Approach (SWAp), and the launch of the National Sanitation Campaign, was a major milestone in the sanitation sector during the period of this TA. Marking a second generation campaign since the Mtu ni Afya, the NSC was launched by the President of Tanzania in 2012. This was a watershed development, since it effectively meant taking off where the campaign ended in the 70s. While the initial campaign was successful in changing behavior from open defecation to fixed point defecation, the NSC sought to convert the behavior or using unimproved sanitation to behavior of using improved sanitation facilities. This was the first campaign in the last few decades to have a pan-Tanzanian approach, to have all regions, districts and villages within its scope; furthermore, it sought to include 100% improved sanitation (including environmental sanitation) in each household and village as its objective. The design of the NSC was heavily influenced by this TA.

The introduction of the National Sanitation Campaign along with its guidelines was followed by the need to have a national sanitation policy in Tanzania. While the NSC will guide the implementation of the Government’s programs, there may be other independent efforts being undertaken by other agencies like NGOs, donors, etc. To offer a comprehensive guideline to all interventions in the country on sanitation, a policy was considered essential. Although there were other policies of the Government which had sanitation as a component, e.g. the National Water Policy (NAWAPO 2002), these did not comprehensively address the issues of sanitation, especially the newly developed thinking currently in the sector.

The TA, supported by other development partners, facilitated the MOHSW in developing in May 2009 a draft National Sanitation and Hygiene policy (see Annex 1) towards the last few years of its time period. Advocacy was initiated with the MOHSW at its highest levels to have the policy adopted. While it has been approved at the ministry levels, it has moved further on to the cabinet and further stages, for final approvals. The resistance at higher levels for a separate policy for sanitation, when sanitation is mentioned in other policies concerning water, health, etc., has resulted



in a delay in its final acceptance and approval. Increased advocacy at the highest levels will have to be undertaken to gain approval for the policy; this will be undertaken in the next phase of the TA.

3.3.2. Institutional arrangementThe sanitation sector found its primary home within the Ministry of Health and Social Welfare. This was through a focused intervention before and during the phase of this TA. The TSSM project was undertaken by the MOHSW, in partnership with WSP. Initially, within the WSDP, the sanitation component was part of the rural water and sanitation component, led by the Ministry of Water. During the restructuring of the project in 2010, sanitation was given a fresh focus within the rural water and sanitation component, with the MOHSW brought in to lead it. Subsequently, the introduction of a separate sanitation component in WSDP phase II, with the MOHSW leading it, cemented its role as the de-facto and de-jure home of sanitation intervention in the country.

In addition to the MOHSW, other ministries like the Ministry of Education and Vocational Training (MOEVT), Ministry of Water (MOW) and Prime Minister’s Office – Regional and Local Government (PMO-RALG) have also assumed responsibilities. While the MOW has continuing responsibility for sanitation issues related to environmental sanitation, MOEVT has assumed leadership role for school sanitation. The PMO-RALG, being the parent ministry of the regional and district level local governments, who actually undertake the implementation, have a central role in coordinating and guiding these institutions while implementation is ongoing. An MOU between the four ministries defines the roles and responsibilities of each, and the reporting and coordination mechanism.

The design of the NSC saw the implementation of the sanitation program being decentralized to the local governments, the Regional Secretariats and Local Government Authorities (LGAs) at the regional and district levels respectively. Further, the ward (sub-district) and village level actors and institutions were also given a central role in the implementation of the campaign.

This institutional arrangement, based on the principle of subsidiarity, ensures that the implementation is done by an institution closer to the people, thereby enabling fine tuning the implementation strategy a suited to the local ground situation. This design of the NSC was influenced in a major way by this TA.

3.3.3. Program methodology The NSC has, as its basic foundation blocks for implementation, adopted Community-Led Total Sanitation (CLTS) and Sanitation Marketing (SM). These were the approaches pilot tested by the TSSM project. This was based on the TSSM theory of change, subsequently built on by the SURS project that prioritized demand creation and enabling supply as the two important components for implementation. The CLTS and SM approaches were both found to effectively facilitate the creation of demand among the people and the supply of sanitation products and services, to enable the households and community reach Total Sanitation status (includes all households being open defecation free and using improved sanitation facilities, and improved environmental sanitation practices). In addition, the NSC also took lessons from the Mtumba approach adopted by WaterAid; this approach combined demand creation and included the presence of san-marts to provide products and services. This approach was similar to the overall approach of the TSSM.

CLTS, as its name suggests, is a community based approach which is used to change the behavior of the community with regard to sanitation. The end outcome of the approach is to achieve Total Sanitation. The approach can be adapted to change behaviors as per the situation, including from open defecation and/or unimproved sanitation to improved sanitation. The expected result of the CLTS intervention is a decision followed by action, by the community to move towards improved sanitation. Similarly, SM facilitates the creation of demand through various approaches, as well as the availability of sanitation products and services to enable the households and communities to move to improved sanitation. Behavior Change Communication (BCC) is used in both approaches in varying ways, some interpersonal, others using mass media, to motivate behavior change.


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Children washing hands with soap during one of the National Sanitation Campaign events

3.3.4. Implementation capacity The building up of the capacity of the institutions was a major activity under the implementation support component of the TA. The primary capacity required, especially at ground levels, was that of creation of demand for improved sanitation among the people. Building the capacity of the foot soldiers, at the ward level, on using the CLTS and SM approaches to build this capacity was the strategy adopted. This strategy involved a cascade level of training, with master trainers at national levels training those below at regional and district levels, and so on. The motivator at the ward level, having his/her capacity enhanced, was expected to use the skills acquired to motivate the villagers to change their sanitation behavior.

To this end, the NSC undertook the following activities:a. SupportingthepreparationofCLTShandbookby

MOHSWThe TA supported an effort by the ministry to prepare a handbook on CLTS. Titled, ‘CLTS Facilitators Guidelines’, this handbook introduced the concept of CLTS, described the various approaches and methods adopted in CLTS and provided overall guidance on how to use CLTS to motivate

villagers to change behaviors. This handbook was released in 2012 and was distributed to all districts.

b. SupportingthepreparationoftechnicalhandbookThe TA supported the preparation of a technical handbook, ‘National Sanitation Options and Construction Guidelines’ by the ministry, in 2012. This handbook focused on the various technology options to construct a toilet, including a conceptual understanding of each option, the material required to construct these, and sanitation for public places including their O&M.

c. PreparationofaCLTStrainingstrategyA strategy for cascade training of knowledge and skills in CLTS approaches was prepared as part of this TA (Annex2: Cover and contents of this strategy). This strategy document defines the cascade model from the national to the regional to district to villages levels, followed by steps for planning and implementation of the strategy. It suggests ways to identify CLTS facilitators, including education qualifications and experience, mentoring and the monitoring of their activities. On the basis of the strategy document, the MOHSW has been rolling out CLTS trainings across the country. A set



Strategic Relevance of the Products for the Water and Sanitation SectorIV.

of master trainers have been created at the national level, who provide training to sub national levels, as part of the cascade model. An institutionalization of the approach has not been undertaken yet, but would be a part of the future phase of the TA.

d. ToolkitformotivatorstochangebehaviorinavillageThe toolkit, ‘How to Improve Sanitation in Rural Areas’ (Annex 3: cover page), is a step by step guide for community motivators to help them facilitate a village to move from open defecation and/or unimproved sanitation to improved sanitation. It provides an overview of the key steps in facilitating rural sanitation improvements at village

Box 2: SOUTH-SOUTH LEARNING VISITS

Because of the effectiveness of learning from one’s peers, the TA undertook a series of south-south learning visits to similar projects and approaches in the southern world.

i. Uganda and Kenya (January 20-26, 2013): This exposure was to the practices adopted for scaling up rural hygiene and sanitation services in Uganda and Kenya including CLTS implementation, verifications systems, enforcement, sector benchmarking, and sanitation marketing, and strengthening the enabling environments. The lessons learned from this visit included:

a. Strong political will with political agenda through Member of Parliament forum, institutional strengthening such as Ministry of Public Health and Sanitation with a role of extension health workers, provision of incentives to Health workers such as allowances, cross-sectoral coordination of sanitation and hygiene at all levels and strong partnership with communities, NGOs and private sectors.

b. Sanitation and hygiene facilities by using local available material, like the tippy tap hand washing facility, bush poles, grasses, and others.

ii. Bangladesh and India (November-December, 2014): A learning visit was undertaken to innovative and scaling up projects in Bangladesh and India. The team looked at sanitation marketing piloting approaches which is working with local level entrepreneurs to build their capacity to provide one stop solutions to households to improve their toilets, coupled with micro credit solutions (engaging with an MFI) for the entrepreneurs and through them, the households. District and state level campaigns to improve the sanitation facilities (from open defecation and unimproved, to improved) and make the villages ODF, large scale monitoring systems and incentive programs at state and national levels were also experienced during the visit. The team learned these lessons from the visit:

a. The local government is the driver of the effective implementation and monitoring of the program, and therefore, the capacity of the local government (human and financial resources, knowledge, capacity, a robust monitoring system, and incentives) are key to sustainable implementation. The coordination of the various government departments at the district level is ensured by the administrative head of the district. Staff engaged from the market for running the campaign and motivating the villagers have made the difference between successful and unsuccessful districts.

b. Reward systems for local governments based on achieving milestones and competition with peers have been effective in scaling up the campaign and address sustainability issues.

c. A private sector facilitation model with MFI involvement, where local entrepreneurs’ capacity have been built, and access to credit opened for them, has enabled an increase in the number of households going up the sanitation ladder and improving their unimproved toilets. The whole process has been facilitated by the local government.


FIGURE 3: KEy STEPS IN FACILITATING RURAL SANITATION IMPROVEMENTS AT VILLAGE AND SUB-VILLAGE LEVELS

Demand Creation

Responding to demand

Community monitoring

Step 1: Planning

Step 2: Triggering

Step 3: Follow-up after triggering

Step 4: Sanitation marketing communication

Step 9: Assisting communities to monitor progress

Step 10: Assisting communities to assess ODF status

Step 11: Checklist for the facilitator

Step 5: Introducing latrine options

Step 6: Introducing finance options

Step 7: Facilitating contacts to suppliers, masons, CBOs, SACCOs

Step 8 Facilitating quality assurance of constructed/improved latrines

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and sub-village levels; the steps including starting up in a village or sub village to all the households in the village access improved sanitation. Use of checklists, hints and ideas, reference to key documents and guidance material, is intended to provide additional support and information to the motivator.

3.3.5. Availability of products and toolsThe primary challenge in sanitation in the rural areas in Tanzania being the need to upgrade from unimproved to improved sanitation, the availability of appropriate products and services assumes significant importance. The unimproved toilets can be converted to an improved one with the addition of a slab with a hole & lid or a pour flush pan, which effectively contains fecal waste by acting as a barrier. While the Joint Monitoring Program (JMP) of the UNICEF/WHO demands a ‘cleanable’ slab, the NSC has opted for a higher level with a demand for a ‘washable’ slab. The TA undertook two interventions to address the need for an improved washable slab:

a. Development and spread of a concrete slab: This initiative was started in the TSSM phase and continued in the subsequent phase as well. A cement concrete based slab was designed with a hole & cover, which can be retrofitted onto an existing unimproved toilet. The slab was given a brand name of Sungura (rabbit), due to the resemblance it had to the animal. Molds for development of the slab at the local level was developed, and shared with LGAs. Local entrepreneurs were trained and motivated to develop Sungura and sell to customers in the rural areas. The slab achieved success in picking up the

adoption of improved toilets in the pilot districts; this was documented by this TA as a learning note.

b. Development and spread of a plastic slab: Building on the work done by WSP and IFC in Kenya, which resulted in the development of plastic based slabs, the TA introduced, towards the end of its term, the slabs in the Tanzanian market. This was done through the private sector company, which had developed and had started manufacturing the slabs in the Kenyan market. The success of this initiative is still unknown, given the early stages of development and marketing of this product.

The TA has initiated a trial assessment of both the cement concrete and plastic slabs, to assess the preferences of the consumer, the willingness to pay, and the required marketing and retail strategy for both of these. The results of the trial are expected by mid-2015.

3.3.6. FinancingThe NSC has adopted a no-hardware-subsidy approach, in line with the principles of the classic CLTS approach. However, financing is required for promotion, i.e. for dissemination of the messages to motivate people to move from unimproved to improved sanitation. In addition, financial resources for administration and logistics required for a campaign such as this is also a necessity. In the WSDP, there were funds available for sanitation, though this was not dedicated funding, and therefore, often would be diverted for water supply requirements.

The TA, during the design and development of the NSC, actively campaigned to ensure that the policy guidelines, is matched by the availability of resources. It actively advocated with other development partner organizations to put in resources for the NSC. This resulted in a major breakthrough in the form of dedicated, ring-fenced funding from African Development Bank (AfDB; approx. USD 21 million) and DFID (approx. USD 3 million).

3.3.7. Cost-effective implementationThe cost-effective nature of the implementation is ensured through two ways, in the NSC, both of which has been influenced by this TA.

Sungura Slab



National Sanitation Campaign edutainment activities in Singida region

Firstly, while designing the NSC, a standard cost of promotion per household was decided upon based on certain parameters and their average costs. This amount of USD 10 per household was the basis of allocation of budgets and subsequent review of performance. Secondly, a performance benchmarking exercise has been initiated during the timeline of this TA; it computes the budget spent by the districts against the actual toilets improved, which gives the efficiency ratio of the district. This enables comparison of the district against the standard parameter, as also against its peers.

3.3.8. Monitoring and evaluationThe monitoring and evaluation component under this TA was undertaken in partnership with another program of assistance around performance monitoring. Two major initiatives were undertaken to improve the monitoring system in the NSC.

a. The technical assistance undertook a comprehensive analysis of the current monitoring system, the challenges therein, and suggested ways to streamline the monitoring system for sanitation. It looked at the routine monitoring systems undertaken by the various ministries (Health, Education and PMO-RALG) as well as periodic monitoring

undertaken by the National Bureau of Statistics (NBS). It looked at the indicators being used by each, their definition (similarities or differences), ways of collection and ways of presenting the results. It recorded the inconsistencies between the various monitoring systems, and suggested ways to reconcile the differences and make the whole process consistent. The results of this project was used by the MOHSW in the development and fine tuning of the National Sanitation MIS (NSMIS), which is the current routine monitoring system available for sanitation.

b. The use of ICT in the development field is an emerging field with significant potential for improving the accountability of results obtained and their sustainability. To test the potential in the rural sanitation monitoring field, the TA undertook a ‘proof of concept’ initiative. A nationwide survey of scientifically random sample households, of the status of sanitation among households was undertaken during the duration of this TA; the survey used mobile phones to collect information on sanitation indicators, fed into a centralized server, where it was collated and analyzed. It is hoped that the results of this


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Box 3: SELLING CONCRETE LATRINE SLABS IN TANzANIA

The primary challenge in the sanitation sector in Tanzania is the shift from the lack of improved toilets; almost everyone has a toilet but an unimproved one. The shift can be made by using a good slab – whether made of concrete, plastic or wood. With a covering of the hole, the fecal-oral chain can be broken, leading to an improved toilet.

The experience of the TSSM project and its documentation has furthered the knowledge in the sector, leading to its further application. The efforts to market plastic and concrete slabs are continuing through this project period. Assessments of the linkages from manufacturer to retailer and the consumer, linkages with microfinance to enable entrepreneurs and consumers to access easy credit were some of the initiatives taken based on the lessons learned out of this learning note.

initiative, which is emerging currently, can be used to institutionalize the approach in the NSMIS; this can enable increasing the quality of the information being collected, leading to better planning and implementation.

3.4. Learning and knowledge managementThe experience with implementing an at-scale sanitation campaign, across the country, is limited in Tanzania and across the world. Experimenting with ideas generated by thinking out of the box would be a useful method to generate new ways of doing things. However, experimentation needs to be accompanied with documenting the processes, results obtained and the lessons learned; on the basis of this, improvement of the implementation of the NSC can be undertaken. Based on the fourth pillar of WSP’s Theory of Change for Scaling-Up Rural Sanitation, a series of learning and knowledge management activities were undertaken during this TA.

• How to sell concrete latrine slabs: learning from rural Tanzania (December 2013) Emerging Learning Note: This note captured the drivers and inhibitors of the concrete latrine slab sales as well as lessons from the experimentation of engaging hardware suppliers from working only with masons

• Improved Sanitation can make Children Taller and Smarter in rural Tanzania (August 2014) (Research Brief ): This brief used secondary data from the Demographic and Health Survey (DHS), 2010, specifically availability of type of toilet, weight and height of children, and based on these, looked at the stunting levels in Tanzania. It found that children are more stunted in communities which practice open defecation or have unimproved toilets.

• Scaling Up Handwashing and Rural Sanitation: Findings from a Baseline Survey in Tanzania (September 2012) (Technical Paper): An Impact evaluation with baseline and end line study to assess the health and welfare impacts of sanitation

was conducted. The results of the study found a statistically significant correlation between the sanitation intervention and main health impacts like diarrhea.

• Economic impacts of Poor Sanitation in Tanzania: Tanzania loses TZS301 billion annually due to poor sanitation: This study provides an estimation of economic impacts on populations without access to improved sanitation in order to provide information on the losses to society of the current sanitation situation.

• How to implement a large scale sanitation program at district level (video): This audio visual tool shows a collection of local government officials describe the process of implementation of the sanitation program across their areas, which offers guidance to others in how to scale up implementation in their areas.



RESULTS, LESSonS LEARnEd And RECoM MEndATIonS

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This TA has contributed significantly to the development of the sanitation sector in Tanzania in the last four years. Just as the inputs of the TA are both upstream (handholding, advice and individual and group interactions) and tangible, so also is the output.

• There has been substantial change in the sanitation sector in Tanzania. The development of the National Sanitation Campaign is a major milestone in the sector. For the first time after the Mtu ni Afya campaign of the 1970s, a campaign national in its coverage and 100% in its outcome scope, was launched. The NSC has within its scope both the rural as well as urban areas; it has included addressing sanitation at households and schools as its mandate. It has, over a period of time, covered all the districts and all the wards across the country. This is much more comprehensive an approach compared to previous efforts.

Transformation of the Sanitation Sector in TanzaniaIV.• The profile of sanitation has increased with it

coming out of the shadow of water supply, to establish its own identity. From sanitation being funded out of the combined water and sanitation budget, to sanitation receiving its own ring fenced budget in 2012, to sanitation becoming a separate component of the WSDP, is proof of the increased importance the country has given to this sector.

• There have been improvements in the enabling environment in the sector. While before the campaign the various parameters of the EE were in the reds and yellows, this has moved to more yellows and greens currently.

• Institutional arrangements and coordination hasbeen enhanced under the NSC. The MOHSW has been tasked with coordinating the overall sanitation issues, in addition to the household sanitation component; the MOEVT has the

FIGURE 4: ENABLING ENVIRONMENT FOR RURAL SANITATION IN TANzANIA – 2012 AND 2014

Policy Strategy and Direction

Institutional Arrangement

Program Methodology

Implementation Capacity

Cost Effective Implementation

Monitoring and Evaluation

Availability of Products and

Tools

Financing0

1

2

3

4

4

6

5 5

3 3 3 3

2

4 4

5

6

5 5

6

5

6

7

Enabling Rural Sanitation Demand and Supply16

mandate of school sanitation. The importance of sanitation within the overall MOHSW has also been increased, with the responsibility been upgraded to a Director level position (from an Assistant Director). There is a dialogue and coordination mechanism in place between the various institutions (MOHSW, MOEVT, MOW and PMO-RALG), with periodic Technical Working Group (TWG) and Water Sector Working Groups (WSWGs) being held to improve coordination in the sector.

• There have been substantial improvements on the ground as well, in terms of the number of toilets and hand washing facilities. While in itself, the numbers are a small percentage of the actual challenge present in the country, what is encouraging is the constant acceleration of achievements seen during this TA period. This has been achieved due to the creation of the enabling

environment at the national level, and the start of creation of similar enabling environments at the sub national (regional and district) levels. Some of the districts have started to prioritize sanitation in their work plans, and have managed to gather impressive results within a short period of time. The program got off to a slow start in the initial periods, due to initial hiccups, including availability of funding. In addition, there has been challenges in fund disbursement in the campaign, which has slowed down the pace of the achievements. Despite this, the campaign is on target to achieve its objectives.

TABLE 1: NSC PROGRESS/RESULTS

year No. of improved toilets

2012-13 31,352

2013-14 384,709


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Learning from the TAV.i. Evidence-based advocacy works: The NSC was built

on the TSSM approach, which piloted-at-scale in 10 districts. The approach and experience from that project was able to generate results which influenced the design of the NSC. Furthermore, during the implementation of the campaign, the lessons learned from the ground through evidence made an impact and was useful in changing mindsets.

ii. Creating an enabling environment takes time to translate to numbers on the ground: The creation of an enabling environment is essential for scaling up. However, this does not immediately translate into numbers on the ground, i.e. actual number of toilets which has turned into improved ones. There will be an increased acceleration visible of the change; the change itself will take a few years to take effect.

iii. Enabling environment of local levels is important: Following from the above learning, the enabling environment at the policy level has to be succeeded by the development of an enabling environment at the implementation level. The implementation of the NSC is being undertaken by the districts, with support from the regions and the national governments.

While the EE at the national and regional levels is a pre-requisite, it is found that this is not enough. There needs to be a robust enabling environment at the LGA (district) level also for the implementation to be undertaken and tangible results in the form of households and villages using improved sanitation facilities. The sub-national program was a response to this need.

iv. Programming the TA depends on the capacity of the Government: This is true at the national level where higher level technical capacity to provide support to lower level institutions and managerial capacity to coordinate the whole program are required, as well as the local government level where managerial and implementation capacity are required. Capacity also includes the presence or strength of institutions. The presence of adequate positions within institutions, for e.g. dedicated personnel at district level to run the campaign, as well as actual people filled into already existing positions (i.e. vacant positions) are challenges which impact the results achieved. Coordination issues between the various ministries are also another issue which impacts the pace at which the program is implemented.


Challenges faced during the TAVI.The TA faced certain challenges during its implementation:

a. The lack of adequate capacity at the national and sub-national levels of the Government, to develop policy and an implementation framework has had its impact on the TA’s ability to maximize the impact on the campaign. This lack of capacity meant that the support provided by the TA could not be fully utilized.

b. The level of coordination between the various ministries at national and sub national level also impacted the achievement of the TA. The coordination especially between the Ministry of Health and Social Welfare, the overall coordinating body for sanitation and hygiene, and the Prime Minister’s Office – Regional and Local Government, the Ministry in charge of the local

governments which implement the sanitation program, was weak; this significantly impacted the achievement of the outputs and outcomes.

c. The profile of sanitation within the Health Ministry has not been high; in an approach which prioritizes curative rather than preventive health, it has been relegated to the level of an Assistant Director. It has not been given adequate attention in both strategic engagements that are likely to be the key frame work for the enabling environment. Recently, the country has completed planning process to include health sector in the second phase of the “Big Result Now” (BRN) initiative followed by development of the Health Sector Strategic Plan IV (HSSP IV). The importance given to sanitation in these processes have been minimal, with sanitation included only as a sub-outcome in the BRN.

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Recommendations for strengthening of NSC VII.On the basis of the experiences of this TA, the following recommendations are made for improving the NSC in the next five years and beyond:a. At the outset, a thorough assessment of the challenges

faced and identifying the gaps that need to be filled in for the TA to continue with the current momentum and with minimum constraint. A targeted strategy to reach the unreached, in line with the twin goals of the World Bank, may be required. Using a horizontal learning process this approach may need to be modified from the current approach of engaging Regional WASH Facilitators, to make it more strategic and streamlined with existing Government structures and systems.

b. The current strategic development plan (MKUKUTA-II) ends in 2015. There exists an opportunity to engage with and support the planning process for the subsequent strategic plan (MKUKUTA III). Following up on the development of this, to influence to the Sanitation and Hygiene Component, will be undertaken.

c. The NSC should increasingly focus on the indicators of the Sustainable Development Goals (SDGs). These include a focus on health centers, highways and transportation sector, and scientific disposal of fecal matter (especially in urban and peri-urban areas), focus on equity issues, among others.

d. Addressing the operational challenges going forward includes the better coordination and clarity of roles among the institutions working in sanitation and hygiene, i.e. Ministry of Health and Social Welfare (MOHSW), Ministry Water (MoW); Education and Vocational Training (MOEVT), Prime Minister’s Office Regional Administration and Local Government (PMO-RALG), and the other ministries concerned with sanitation provision for SDG.

e. The further strengthening of institutions, especially at local levels, is critical for taking the implementation of the NSC forward. Availability of managerial and implementation positions, filling up of vacancies wherever such positions already exists, and building capacity of the staff to fulfil their roles are important steps required to be taken.

f. The partnership with the private sector and others stakeholders like Microfinance Institutions needs to be strengthened. Modalities of engaging with the private sector for interventions at scale needs to be identified and implemented. This will take forward the engagement started in the last few years, and ensure an institutionalization of the partnership.

g. The strengthening of the routine and periodic monitoring system is a pre-requisite to getting the desired outcomes. Since ‘what you monitor is what you get’, the monitoring system should be strengthened to focus on the correct indicators (improved sanitation, ODF communities, etc.), the institutional structure for monitoring (upward and downward flow of information) along with appropriate incentives for those involved in collecting and disseminating data and information, and the use of the information collected in improving the implementation of the NSC to meet the SDGs.

h. Increased profile for sanitation within the Ministries and the Government is critical. Raising the engagement within the Ministry to a Director level, increased advocacy for budgetary support for sanitation are some of the outcomes desired. Sustained efforts are required to be undertaken to keep WASH as one of the key priorities of the BRN (Health) as well as the health sector strategic plans. Including sanitation as one of the indicators for tracking of the Results Based Financing (RBF) project (supported by the World Bank), including linking the National Sanitation MIS (NSMIS) to the existing District Health Information System (DHIS2) need to be explored and operationalized. Sanitation should also be part of the district health profile created by each LGA. An increased role for the proposed Community Health Workers (CHWs), who will paid based on performance, to be involved in sanitation outcomes should also be considered.

i. Urban Sanitation: The future engagement should increase the focus on supporting pro-poor urban sanitation and hygiene to complement the World Bank operation under preparation. In order to achieve the SDGs in sanitation, the urban poor must be given the same prominence as the rural population.


annex 1: draft Sanitation Policy – Cover page, table of contents and Forward

THE UNITED REPUBLIC OF TANZANIA

MINISTRY OF HEALTH AND SOCIAL WELFARE

SANITATION AND HYGIENE POLICY

DRAFT ONE

January2011

Report of the Technical Assistance provided to the National Sanitation Campaign, Government of Tanzania | Annex 1: Draft Sanitation Policy – Cover page, table of contents and forward

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TABLE OF CONTENTS

TABLEOFCONTENTS....................................................................................................................................................................................... iDEFINITIONS..................................................................................................................................................................................................... iiiFOREWORD....................................................................................................................................................................................................... iv

1.0 INTRODUCTION ............................................................................................................................................ 12.0 SITUATION OF SANITATION AND HYGIENE SERVICES IN THE COUNTRY .......................................... 2

2.1 Implementation of sanitation and hygiene activities ............................................................................................22.1.1 Weakness..................................................................................................................................................22.1.2 Challenges ................................................................................................................................................3

3.0 RATIONALE ..................................................................................................................................................... 44.0 VISION, MISSION AND OBJECTIVES OF THE POLICY ............................................................................. 5

4.1 VISION .............................................................................................................................................................54.2 MISSION ..........................................................................................................................................................54.3 OBJECTIVE ......................................................................................................................................................5

4.3.1 Specific objectives .....................................................................................................................................55. 0 POLICY ISSUES AND STATEMENTS ............................................................................................................. 6

5.1SanitationandHygieneathouseholdlevels.........................................................................................................................65.1.1 Sanitation and hygiene services in rural household ...................................................................................65.1.2 Sanitation and Hygiene services in urban household ................................................................................75.1.3 Behaviour Change in Sanitation and Hygiene Practices ...........................................................................75.1.6 Investing in Sanitation and Hygiene at Households level ..........................................................................85.1.5 Community participation in sanitation and hygiene activities. .................................................................95.1.6 Occupational Health and Safety ...............................................................................................................95.1.7 Diseases and risks due to poor sanitation and hygiene ...........................................................................105.1.8 Food safety .............................................................................................................................................115.1.9 Management of solid and liquid waste ..................................................................................................115.1.10 Participation of Private Sector and Non-Governmental Organizations ...................................................125.1.11 Technologies of Sanitation and Hygiene .................................................................................................12

5.2SchoolWater,SanitationandHygiene...................................................................................................................................135.2.1 Improved Latrines and bathrooms ..........................................................................................................135.2.2 Hygiene Practices ...................................................................................................................................145.2.3 Availability of clean and safe Water .........................................................................................................145.2.4 Financing ...............................................................................................................................................155.2.5 Environmental Health ...............................................................................................................155.2.6 Management of Solid Waste ...................................................................................................................165.2.7 Diseases ..................................................................................................................................................165.2.8 Sectoral Coordination ............................................................................................................................175.2.9 Community and Private Sector Involvement ..........................................................................................18

5.3 SanitationandHygieneInInstitutions................................................................................................................................195.3.1 Healthcare Facilities ...............................................................................................................................195.3.2 Industries, Factories and Garages ............................................................................................................195.3.3 Hotels, Restaurants and Guest Houses ...................................................................................................205.3.4 Worship Places .......................................................................................................................................205.3.5 Orphanages and Elderly Care Centres ....................................................................................................215.3.6 Police, Military Camps and prisons ........................................................................................................21

Report of the Technical Assistance provided to the National Sanitation Campaign, Government of Tanzania | Annex 1: Draft Sanitation Policy – Cover page, table of contents and forward Report of the Technical Assistance provided to the National Sanitation Campaign, Government of Tanzania | Annex 1: Draft Sanitation Policy – Cover page, table of contents and forward


5.3.7 Refugees camps ......................................................................................................................................225.3.8 Office Premises .......................................................................................................................................225.3.9 Higher Learning Institutions ..................................................................................................................23

5.4. SanitationandHygieneinPublicPlaces............................................................................................................................245.4.1 Markets, Trade Fairs (Exhibitions) and Recreational Areas ......................................................................245.4.2 Platform and Terminals ..........................................................................................................................245.4.3 Open Spaces ...........................................................................................................................................255.4.4 Solid Waste Disposal Sites ......................................................................................................................255.4.5 Waste Water Treatment Plants ................................................................................................................265.4.6 Burial Places ...........................................................................................................................................265.4.7 Informal Mining Camps ........................................................................................................................275.4.8 Fuel Stations ..........................................................................................................................................275.4.9 Fishing Camps, Fish Markets and Abattoirs ...........................................................................................285.4.10 Yacht Clubs and Beaches ........................................................................................................................285.4.11 Plantation Areas .....................................................................................................................................295.4.13 Warehouses ............................................................................................................................................295.4.14 Public Toilets ..........................................................................................................................................30

6.0 CROSS CUTTING ISSUES .............................................................................................................................. 316.1 EmergencyAndDisaster.........................................................................................................................................................316.2 Gender,EquityAndSpecialGroups.....................................................................................................................................316.3 Environment.................................................................................................................................................................................326.4 FinancialAndHumanResources..........................................................................................................................................336.5 ProfessionalCapacityBuildingInSanitationAndHygiene.........................................................................................336.6 Research.........................................................................................................................................................................................346.7 InformationAndCommunicationTechnology(Itc).......................................................................................................346.8 PublicPrivatePartinership......................................................................................................................................................356.9 Hiv/Aids..........................................................................................................................................................................................356.10Poverty...........................................................................................................................................................................................366.11GoodGovernance......................................................................................................................................................................376.12HumanRights..............................................................................................................................................................................376.13MonitoringAndEvaluation.....................................................................................................................................................38

7.0 INSTITUTIONAL FRAMEWORK ................................................................................................................. 397.1 Organizationalstructureandresponsibilitiesatvariouslevels.................................................................................397.2 Household.....................................................................................................................................................................................397.3 Village/Mtaa.................................................................................................................................................................................397.4 Ward................................................................................................................................................................................................397.5 District,Town,Municipalandcitycouncils.......................................................................................................................397.6 Region............................................................................................................................................................................................407.7 Zone................................................................................................................................................................................................407.8 National..........................................................................................................................................................................................407.9. Otherpublicsectors..................................................................................................................................................................417.10Privatesector................................................................................................................................................................................427.11Civilsocietyorganization.........................................................................................................................................................427.12Developmentpartners.............................................................................................................................................................427.13TheMedia......................................................................................................................................................................................42

8.0 LEGAL FRAMEWORK .................................................................................................................................... 449.0 CONCLUSION ................................................................................................................................................ 45

Report of the Technical Assistance provided to the National Sanitation Campaign, Government of Tanzania | Annex 1: Draft Sanitation Policy – Cover page, table of contents and forward

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FOREWORD Environmental Sanitation and hygiene is the hygienic means of preventing human contact from hazards of wastes in a manner which cannot be a source of diseases or physical injury. Improvement of sanitation and hygiene in the country will help preventing communities from diseases, injury and other health hazards.

Government has continued to improve sanitation and hygiene activities to all people in order to enhance their health and environment. Government recognizes the importance of sanitation and hygiene in improving people’s health hence increases their productivity. Sanitation and hygiene activities have continued to be implemented under 1990 Health Policy which was revised in 2007. Since then there have been a lot of scientific and technological innovations leading to environmental pollution. Culminated to emerging diseases. There is rapid increase in population leading to increase in production of unmanaged waste.

Sanitation and hygiene is a cross cutting issue which is being implemented by different actors. However, the implementation of these activities is inadequately coordinated. In view of this, the Government has decided to develop a Policy which provides vision, mission and policy statements to enhance coordination Sanitation and Hygiene activities in the country.

The Ministry anticipates that all stakeholders involved in sanitation and hygiene will read, understand, translate and utilise the policy during planning, implementation and evaluation of sanitation and hygiene activities in the country.

The Ministry would like to acknowledge all who participated in development process of this policy. I believe t all stakeholders are going to participate fully in implementation of this policy with an objective of improving health status of all people in the country.

Hon. Dr. Hadji H. Mponda.(MP)MINISTER OF HEALTH AND SOCIAL WELFARE

Report of the Technical Assistance provided to the National Sanitation Campaign, Government of Tanzania | Annex 1: Draft Sanitation Policy – Cover page, table of contents and forwardReport of the Technical Assistance provided to the National Sanitation Campaign, Government of Tanzania | Annex 1: Draft Sanitation Policy – Cover page, table of contents and forward


annex 2: CLtS roll out Strategy (Cover page and Contents)

UNITED REPUBLIC OF TANZANIA

MINISTRY OF HEALTH AND SOCIAL WELFARE

NATIONAL SANITATION CAMPAIGN

STRATEGY FOR ROLLING OUT AND SUSTAINING CLTS FACILITATORS

FINALVERSION

March2014

Report of the Technical Assistance provided to the National Sanitation Campaign, Government of Tanzania | Annex 2: CLTS roll out strategy (Cover page and contents)

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TABLE OF CONTENTS

TABLEOFCONTENTS....................................................................................................................................................................................19ABBREVIATIONSANDACRONYMS..........................................................................................................................................................21

1.0 INTRODUCTION ..............................................................................................................................................1.1 Background..................................................................................................................................................................

1.2 Justification for Adoption of CLTS Approach .......................................................................................................1.3 Proposed CLTS Capacity Building Program .........................................................................................................

1.3.1 CurrentStatus........................................................................................................................................................................1.3.2 CLTSCapacityBuildingNeedsatDifferentLevels.....................................................................................................

1.3.2.1 NationalLevel........................................................................................................................................................1.3.2.2 DevelopmentofaPoolofNationalCLTSFacilitators...............................................................................1.3.2.3 RegionalLevel........................................................................................................................................................1.3.2.4 LGALevel.................................................................................................................................................................1.3.2.5 CommunityLevel..................................................................................................................................................1.3.2.6 EnvisagedTasksofCommunityLevelCLTSFacilitators..........................................................................1.3.2.7 SpecificTasksofCommunityLeaders...........................................................................................................1.3.2.8 TasksofCommunityMembers........................................................................................................................

2.0 PLANNING AND IMPLEMENTATION OF CLTS CAPACITY BUILDING PROGRAM ..........................2.1 Engaging NCLTS Facilitators ...............................................................................................................................2.2 Selection of Community Level CLTS Facilitators ..................................................................................................

Table2.1:StepbyStepforSelectingCLTSFacilitators.........................................................................................................2.3 Eligibility Criteria .................................................................................................................................................2.4 Assessment Process ................................................................................................................................................2.5 Development of a Standardized CLTS Training Package .......................................................................................2.6 Training Program ..................................................................................................................................................

Table2.2:SummaryofCLTSCapacityBuildingNeeds........................................................................................................2.6.1 TOTTrainingforNationalFacilitators.............................................................................................................................2.6.2 TrainingofCommunityLevelCLTSFacilitators..........................................................................................................2.6.3 PracticalSkillsinWorkshopandFieldSetting............................................................................................................2.6.4 Certification............................................................................................................................................................................2.6.5 TrainingofRSsandLGAs....................................................................................................................................................2.6.6 FieldCoachingandMentoring........................................................................................................................................2.6.7 MonitoringofCLTSCapacityBuildingProcess...........................................................................................................

3.0 PROPOSED STRATEGY FOR DEPLOYMENT AND SUSTAINING CLTS FACILITATORS ....................3.3 Clustering of LGAs per Region/Zone ...................................................................................................................

Table3.1:DivisionofRegionsandDistrictsperZone..........................................................................................................3.4 Sustaining CLTS Facilitators .................................................................................................................................

Annex1:RequestforExpressionofInterest(EoI):NationalCLTSFacilitators...............................................................................Annex2:SampleFormatforProfilesofCLTSCourseParticipants....................................................................................................

Report of the Technical Assistance provided to the National Sanitation Campaign, Government of Tanzania | Annex 2: CLTS roll out strategy (Cover page and contents)Report of the Technical Assistance provided to the National Sanitation Campaign, Government of Tanzania | Annex 2: CLTS roll out strategy (Cover page and contents)


annex 3: toolkit for Community motivators

How to Improve Sanitation in Rural AreasA Step-by-Step Guide for Community Facilitators

The United Republic of TanzaniaMinistry of Health and Social Welfare

and Water and Sanitation Program

June 2014

Report of the Technical Assistance provided to the National Sanitation Campaign, Government of Tanzania | Annex 3: Toolkit for Community Motivators)

www.wsp.org 27

Who is this guide for?This guide has been developed for the facilitators of rural sanitation activities at village and sub-village level, i.e. extension staff at district and ward levels as well as NGO and private sector facilitators (in the following referred

Report of the Technical Assistance provided to the National Sanitation Campaign, Government of Tanzania | Annex 3: Toolkit for Community Motivators) Report of the Technical Assistance provided to the National Sanitation Campaign, Government of Tanzania | Who is this guide for?

to as “community facilitators”). It is designed to help these community facilitators in their day-to-day role of improving sanitation in rural areas and making villages open defecation free.

May 2015

Water and Sanitation Program

Water Global Practice, World Bank50 Mirambo StreetP.O. Box 2054Dar es SalaamTanzania.

Contact: C. Ajith Kumar Phone: +255-222-16-3224 E-mail: [email protected] sites: www.worldbank.org/waterwww.wsp.org

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